Most cases of hepatocellular carcinoma are already in the middle and advanced stages or have other diseases that prevent them from undergoing surgery when they are diagnosed. Interventional hepatic artery infusion chemoembolization via catheter can effectively control the growth of the cancer, which has become a common treatment method for liver cancer that cannot be surgically resected in the middle and late stages, and is also effective for both primary liver cancer and metastatic liver cancer.
Pre-interventional care for advanced hepatocellular carcinoma patients
1.Basic care: Patients should pay attention to nutritional supplementation before surgery, encourage patients to consume easily digestible diet with high nutrition, high vitamin and low fat, and ensure sufficient sleep. Preoperative surgical field skin preparation, iodine allergy test, 4h preoperative fasting. Complete all preoperative examinations. After the patient is admitted to the hospital, the responsible nurse is in charge. In order to make the interventional treatment safe and smooth and reduce toxic side effects, the responsible nurse must have the relevant information about the patient before treatment, such as the patient’s condition and psychological state; the development of the disease and treatment; the patient’s awareness of the current treatment plan, etc. At the same time, the patient’s physical condition should be evaluated, including nutritional status, physical examination and laboratory tests. If the patient’s physical condition is poor, such as extreme wasting, anemia, platelets and white blood cells below the normal value, the patient should first strengthen the supportive therapy, and then carry out this treatment after the physical condition improves.
2.Pre-operative care
(1) Knowledge education: Provide patients and family members with knowledge about disease treatment, rehabilitation and professional nursing guidance, and guide patients in self-care according to the relevant nursing issues to help establish an effective knowledge system and master self-care skills.
(2) Health education: Patients with advanced lung cancer mostly have different degrees of psychological barriers and lack confidence in interventional treatment, showing doubts, fears and tensions. The responsible nurse must patiently and meticulously do the psychological guidance and explanation work, explain in detail the basic treatment principle and process of interventional therapy, care for patients and relieve their pain in time, so that patients can receive treatment in the best condition. The importance and necessity of postoperative bed rest and limb braking should be explained to the patients and their families, and the patients should be trained to urinate and defecate in bed.
(3) Pre-operative routine preparation: liver and kidney function, blood routine and prothrombin time should be routinely checked before surgery. 6h before surgery, the patient should be asked to wash the skin of the puncture site and do the skin preparation in the inguinal area bilaterally. Do iodine and penicillin, procaine allergy test as prescribed by the doctor.
3.Psychological care
Most patients of interventional therapy show irritability, fear, anxiety, pessimism, etc. They are skeptical of treatment or have high expectations of treatment. Therefore, medical and nursing staff should communicate with patients and family members more often to understand patients’ knowledge of the disease and their psychological reactions, so as to provide targeted psychological care and formulate effective health education plans according to each person.
For patients who are psychologically sound, cheerful and optimistic and informed about the disease, nurses should give more encouragement, patiently and carefully explain the process of interventional treatment, possible side effects and treatment principles, increase the patient’s confidence in overcoming the disease and improve the patient’s self-protection ability. For patients who are psychologically fragile and do not know about the disease, nurses should be cautious, euphemistic and optimistic in communication with them, mobilize patients’ enthusiasm, convey a positive mental state to patients, and improve their psychological defense ability, while communicating more with family members to obtain their cooperation and establish a joint participatory nurse-patient relationship so as to improve the treatment effect.
Interventional care for patients with advanced liver cancer.
In the process of interventional treatment, in addition to the psychological care of patients, nurses should closely observe the injection of drugs, pay attention to the operation of embolic agent, and avoid the return of embolic agent into non-target vessels; closely observe the changes of patients’ vital signs, if there are symptoms such as irritability, chills and cyanosis, increase the flow and concentration of oxygen supply immediately, and prepare for emergency treatment; observe the coughing of sputum and sputum secretion at any time, and give timely treatment. Give timely treatment.
Post-interventional care for patients with advanced hepatocellular carcinoma
1.Puncture site care
The patient should rest in bed absolutely for 24h, pressurized salt bag at the puncture site for 6h to avoid wound infection caused by the leakage of dust from the sand bag, and the patient should be braked with the limb on the operated side straight for 8h. The patient should closely observe the skin temperature, dorsal foot artery pulsation and skin color of the operated limb, observe whether there is bruising and hematoma on the skin of the puncture site, whether there is contamination of the dressing and whether the salt bag is displaced, and deal with the abnormalities in time.
(1) local care of puncture: the most common complication of interventional treatment is local hematoma of puncture, so after 15 min of postoperative puncture point compression with a roll of bandage to compress the puncture point, perform bandage compression bandage, brake the limb on the operated side in the straight position for 8 h, and the patient is bedridden for 12 h. Closely observe the puncture site for blood oozing and subcutaneous bruising, if there is blood oozing, the dressing should be changed in time to keep the puncture point dry and prevent infection.
(2) Closely observe the changes of patients’ vital signs: postoperative changes in body temperature, pulse, blood pressure and limb color should be noted, especially the pulsation of the dorsalis pedis artery on the operated side and the peripheral blood flow and skin temperature.
(3) Hydration care: Since local infusion of large doses of anti-cancer drugs has obvious toxic side effects, hydration therapy is especially important. Encourage the patient to drink more water, not less than 2500ml per day, and urination requires more than 3000ml, so that drug toxins can be excreted through the kidneys as soon as possible.
(4) Monitoring of body temperature: closely observe the change of body temperature, and give timely physical cooling according to the condition, and if necessary, use drugs to lower the temperature. Change bed sheets, sheets and pants in time when sweating is high, and provide good oral and skin care.
(5) Care of gastrointestinal reactions: postoperative fasting should be 4-6h, due to the adverse reactions of chemotherapy drugs, which can cause nausea and vomiting symptoms. Care to do a good job in explaining the work, give gastric complexan, cardan injection, so that the gastrointestinal reaction is reduced. Diet should be light, a small number of meals, strengthen oral care, reduce adverse stimulation, and promote toxin excretion.
(6) Pain care: Within 2-3 days of interventional treatment, tumor necrosis can cause pain in the tumor area. The nurse should do a good job of comforting the patient while strengthening the observation of the condition. When the pain is intolerable, closely observe the location, nature and degree of pain in order to distinguish it from the pain caused by other complications, and use painkillers when necessary according to medical prescription.
2.Observation and care of complications
Post-embolization syndrome is a common complication after embolization treatment, mainly manifested as fever, abdominal pain, nausea, vomiting and paralytic intestinal depression. Nurses should closely observe the changes of patients’ vital signs, patrol the ward once every 30 min, and take the temperature once every 4 h. If the body temperature is too high, give alcohol bath and ice pack in time, and give medicine to cool down the temperature if necessary, and pay attention to keep warm, prevent from getting cold, and replenish water in time to avoid hypothermia. To prevent infection, antibiotics can be used before and after surgery. In case of severe pain in the right upper abdomen, apply analgesics. Pay close attention to the changes of dyspnea, coughing, cyanosis, respiratory rate, heart rate and heart rhythm, and give timely treatment if there is any abnormality.
Dietary considerations for advanced liver cancer intervention.
1.Food should be easy to digest
In the arrangement of diet for advanced hepatocellular carcinoma, special attention should be paid to give easily digestible food. There must be a certain amount of staple food, such as wheat flour, corn, sweet potato, millet, etc.; vegetables and fruits, such as tomato, rape, lettuce, cauliflower, kiwi, orange, strawberry, etc.; meat, soybean products, and milk and dairy products.
2.Reducing the intake of fat
Because liver cancer patients have obstacles in digestion and absorption of fat. Therefore, especially in the arrangement of late stage liver cancer diet, it is not advisable to consume too much fat. Foods such as fatty meat, fried foods, dried fruits and sausages should be forbidden. A low-fat diet can not only reduce the digestive symptoms of liver cancer patients, such as nausea, vomiting, abdominal distension, etc., but also reduce the degree of pain in the liver area to a certain extent with less fat in the diet.
3.The diet of advanced liver cancer should be supplemented with more vitamins
Vitamins A, C, E, K, etc. have certain auxiliary anti-tumor effects. Vitamin C is mainly found in fresh vegetables and fruits. Carotene can be converted into vitamin A after entering the body, so liver cancer patients should eat more animal liver, carrots, cauliflower, yellow flowers, cabbage, figs and dates. Meanwhile, they should also eat more fresh vegetables and fruits, such as radish, pumpkin, bamboo shoots, asparagus, apple, umeboshi, kiwi, etc.
4.Eating more fresh fruits
Patients with advanced liver cancer are suitable to choose fruits that strengthen the spleen and stomach, such as hawthorn, orange, lemon, orange, rooibos, dragon fruit, jujube, banana, etc., and eat them selectively according to their own conditions, but the fruits must be fresh, mature and eaten in moderation, and fruits stored for too long will produce toxic substances, which will damage the liver and aggravate the deterioration of the disease.
5.Save vegetables rich in coarse fiber
Patients with advanced liver cancer also have restrictions on vegetables. Less vegetables rich in coarse fiber: celery, cauliflower, nori, kelp, wide pear, bamboo shoots and other foods with more dietary fiber should be consumed less. Even if they are consumed, they should be cooked softly, boiled and chewed slowly.